Male Pathology - Testis Flashcards
What is cryptorchidism?
When one or both testes do not descend properly into the scrotum
hCG dependent process
May be found in the inguinal canal, the upper scrotum, or within the abdomen
Infertility is the most frequent complication
Germ cell tumors 4-10 times more likely
What are some common causes of epididymitis?
UTI (>35)
STI (<35)
Gonorrhea, Chlamydia, TB, E coli, Pseudomonas
What sign is positive with epidiymitis?
Prehn’s sign
Elevation of the scrotum decreases pain
What are some common causes of orchitis?
Acute Epidiymitis
Twisting of the spermatic cord that cutts off the venous/arterial blood supply
Torsion of the Testis
What are some predisposing factors to torsion of the testes?
Violent movement or physical trauma (most common)
Cryptorchid testis
Atrophy of testis
What are some clinical findings with torsion of the testis?
Sudden onset testicular pain
Negative Prehn’s sign
Needs surgery to prevent hemorrhagic infaction of the testis
Risk factors for testicular cancer
What are the three types of intratubular germ cell neoplasias?
Seminoma (40%, age 40s)
Mixed (30%)
Non-seminomatous (30%) – Embryonal ca., yolk sac tumor, choriocarcinoma, teratoma (mature or immature) age 20-30s
What percent of patients with ITGCN develop an invasive germ cell tumor within 7 years?
>70%
Involvement is pathy and 40% are bilateral
Two 3mm testicular biopsies will identify the majority of patients with ITGCN.
Spermatogenesis is absent in involved tubules - cells are atypical with nuclear enlargement and large nucleoi
DNA content is aneuploid; contains isochromosome 12p, like seminoma
Red - Sertoli
Germ cells - Dark red
ITGCN
Sertoli cells (red)
Germ cells (dark red)
Seminoma
Mean patient age 40s
Arranged in solid nests separated by fibrous septa; lymphoid infiltrate
Seminoma cells (almost whole area)
Vessel - invaded with seminoma cells
“Square” nuclear contours due to molding
Markers for Seminoma
a-fetoprotein (AFP): usually normal
B-human chorionic gonadotropin (hCG): can be elevated
What are non-seminomatous germ cell tumors sensitive to?
They are chemosensitive but not radiosensitivity
What are the 4 types of non-seminomatous germ cell tumors?
Embryonal carcinoma
Yolk sac tumor
Choriocarcinoma
Teratoma (mature and immature)
Embryonal carcinoma
Age 20-30s
Fleshy gray-white tumor with prominent necrosis
There is a solid pattern of embryonal carcinoma, which can simulate seminoma
Cells of embryonal carcinoma are large with vesicular nuclei, prominent nucleoli, glandular structures
2nd most common germ cell tumor
Metastases in up to 40%
Serum AFP is normal
B-hCG is elevated in 60% of cases
Most common germ cell tumor in infants/children - 90% are cured by orchiectomy
In adults – component of mixed germ cell tumor
Yolk Sac Tumor (endoermal sinus tumor)
Main tumor marker = elevated serum alpha-fetoprotein (AFP)
White to tan masses with myxoid and cystic changes
Yolk Sac Tumor
Deposition of basement membrane material, and Schiller-Duval bodies are characteristic –> central vessel rimmed by loose connective tissue that in turn is lined by malignant epithelium, all within a cystic space
Pure form - mean age of 20 months, in children, no metastases
In adults - mixed germ cell tumor and is identified in >50% of mixed tumors
Teratoma
Immature vs Mature Teratoma
Mature = somatic-type tissues that can include intestine-type glands, respiratory epithelium, cartilage, muscle, squamous epithelium
Immature = immature neuroepithelium, blastema, carcinoid, or cellular stroma –> WORSE outcome
Teratoma
Respiratory epithelium (left)
Fat cells (right)
Metastases to brain or lungs
Serum B-hCG elevated
Poorer prognosis, but tumor is sensitive to chemotherapy
Multinucleated syncytiotrophoblastic cells and mononuclear cytotrophoblast or intermediate trophoblast
Stain hCG+
Choriocarcinoma
Leydig cell tumor - clear cytoplasm, cells are not nested
Majority in adults (80%)
10-17% malignant
Unilateral with rare exceptions
Benign treated with orchiectomy
Malignant require retroperitoneal lymph node dissection
Sertoli cell tumor – closely packed cords
<1% of testicular tumors
Malignant in 10% of cases
Estrogen production by the tumor can result in gynecomastia and impotence
Lymphoma
Most common testis tumor over age 60
Usually result of secondary spread
20% bilateral
White to tan fleshy tumor - interstitial growth pattern with sparing of seminiferous tubules
Most are diffuse large cell types with a B-cell phenotype
What is the most common tumor of the epididymis?
Adenomatoid tumor
May also be identified in tunica albuginea and spermatic cord
Adenomatoid tumor
Circumscribed, gray-white
May extend into rete testis and testis
Always benign
Probably mesothelial origin
What is the most common cause of scrotal swelling?
Hydrocele
Vasitis Nodosa
Usually observed after vasectomy, blind end of transected vas deferens
Sperm-containing ductules that extend into stroma
Resembles invasive adenocarcinoma, but the prescence of sperm, chronic inflammation and lack of atypia.
Metastases to the testis: #1 is prostate cancer
